Allocation of scarce critical care resources during public health emergencies: which ethical principles support decision making. 2022

A J Fauci, and R Latina, and L Iacorossi, and D Coclite, and D D'Angelo, and A Napoletano, and I Terrenato, and P Iannone
National Centre for Clinical Excellence Healthcare Quality and Safety, Istituto Superiore di Sanità, Rome, Italy.

To investigate whether and how ten ethical principles are mentioned within documents on critical care resources allocation during public health emergencies. We conducted a search of documents con-cerning critical resources allocation during public emergencies publicly available from Google and two specific international websites, up to November 2020. Each document was analyzed by two independent reviewers to assess whether a reference to any of the 10 key ethical principles indicated by the Northern Italy Ethical Committee could be found in the documents. Cohen's K statistic was used. We obtained 34 documents, of which 19 were allocation frameworks, 15 crisis standards of care, 4 clinical triage protocol, 3 clinical guidelines and 2 public health emergency response plans. The principles most frequently mentioned as important for decision-making was "number of lives saved", followed by "transparency", "equity", "respect of person and their autonomy". The most cited tiebreakers were "younger first/life cycle" and "lottery". All documents aim to protect the life and health of the largest number of people and should be objective, ethical, transparent, applied equitably, and be publicly disclosed. It is plausible that short- and long-term prognostic tools can help allocate critical resources, but it remains strong that the decision-making process must be guided by a multi-principle ethical model that is not always easy to apply.

UI MeSH Term Description Entries
D011634 Public Health Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. Community Health,Environment, Preventive Medicine & Public Health,Environment, Preventive Medicine and Public Health,Health, Community,Health, Public
D003422 Critical Care Health care provided to a critically ill patient during a medical emergency or crisis. Intensive Care,Intensive Care, Surgical,Surgical Intensive Care,Care, Critical,Care, Intensive,Care, Surgical Intensive
D003657 Decision Making The process of making a selective intellectual judgment when presented with several complex alternatives consisting of several variables, and usually defining a course of action or an idea. Credit Assignment,Assignment, Credit,Assignments, Credit,Credit Assignments
D004630 Emergencies Situations or conditions requiring immediate intervention to avoid serious adverse results. Emergency
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014218 Triage The sorting out and classification of patients or casualties to determine priority of need and proper place of treatment. Triages
D015276 Health Care Rationing Planning for the equitable allocation, apportionment, or distribution of available health resources. Allocation of Health Care Resources,Allocation of Healthcare Resources,Rationing, Health Care,Healthcare Rationing,Healthcare Resources Allocation,Healthcare Resources Allocations,Rationing, Healthcare,Resources Allocation, Healthcare
D058873 Pandemics Epidemics of infectious disease that have spread to many countries, often more than one continent, and usually affecting a large number of people. Pandemic

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